It is really very heartbreaking when you are unable to conceive even after trying dedicatedly over a couple of months. With a heavy heart you decide to visit an infertility specialist. After undergoing many tests, most of the time a reason can be found as the cause of your problem. There are many causes of infertility. It can be menstrual irregularities, PCOD (ovulation defects), Tubal blockage or semen abnormalities etc. It is also a relief if one or other cause of infertility can be identified because now treatments can be prescribed targeting that particular problem. Even more disheartening is the situation when no one is able to find out the reason behind your turmoil. All the tests are normal, there is nothing wrong grossly even then you are being devoid of motherhood. This is called as unexplained infertility. Earlier 10 percent of the infertile couples were being labelled as having unexplained infertility. But quite recently, it seems like to be a major proportion of whole pool. 

Following is the list of underlying reasons of infertility

Endometriosis - In most of such cases, everything seems normal, tubes are not blocked, ovulation is occurring timely etc. But when we do laparoscopy then the diagnosis of endometriosis is being made. Treatment options in such cases depend upon the severity of the disease. In cases of minimal and mild endometriosis,  Superovulation & IUI ( intrauterine insemination) can be planned for 2-3 cycles. In cases, there is no success with IUI, you can move to IVF. But waiting and sitting idle is usually of no benefit even may be detrimental because whatever corrections have been done via laparoscopy may revert back in 6 or more months. In cases of moderate and severe Endometriosis, its advisable to directly go for IVF without wasting any time.

Semen factor - High DNA fragmentation Index- Mostly, sperm count and motility is being measured while doing semen analysis. Majority of the times even morphology (how do sperms look? Normal or abnormal) is also not mentioned. According to WHO, in cases with severely abnormal sperms (i.e. less than 4% normal morphology), such a couple should be advised to plan IVF with ICSI ( where we take out eggs and sperms in lab & deliberately inject normal looking sperms into the eggs). Majority of the times, females are being tested again and again to find out the cause of infertility while ignoring this trivial but important factor. 

Genetic abnormalities in eggs - There are certain defects at molecular level. We come to know about them when such a couple undergoes IVF. Many a times, normal looking follicles in ultrasound are found to be empty during egg retrieval for IVF. Sometimes, though we are able to get eggs but the quality if eggs is not that good. Some of them fail to fertilize, some fail to grow while some though survive till day 5 forming a blastocyst but not a good quality embryo. With the advent of science in the field of genetics, we may overcome these obstacles in future. Right now we need to plan IVF cycles in a very customised way for such patients for enabling them to have a baby of their own. Most important aspect in such cases is accurate diagnosis and timely management, because with advancing age there is inherent decline in egg quality. It is really very disheartening for women to know that their eggs are rapidly declining in quantity & quality after 35yrs of age, while there is hardly any role of age on semen parameters of their partners. But it is actually quite relieving that modern medicine has opened the doors of parenthood for such couples too.